Major
naproxen × Rivaroxaban
NSAID, propionic acid derivative×Direct oral anticoagulants (factor Xa inhibitors)
Mechanism
Direct oral anticoagulant (rivaroxaban) + NSAID (naproxen) – additive GI bleeding risk.
Symptoms
Black or tarry stools, vomiting blood, epigastric pain. Risk multiplies in older patients and with prior peptic ulcer disease.
Management
Avoid prolonged combination. If naproxen is needed for a short course, use the minimum effective dose for 5–7 days under pantoprazole cover. For chronic analgesia: paracetamol or celecoxib.